Missouri's attorney general opened a new front in the GOP's attacks on transgender people: banning treatment for any adult with depression

• Missouri's attorney general announced new requirements for adults seeking gender affirming care.
• Adults with depression are banned from seeking care until their mental health issues are resolved.

An emergency regulation announced by Missouri's attorney general on Thursday could severely limit access to gender-affirming care in the state, setting several new requirements for trans adults seeking treatment.

Attorney General Andrew Bailey's sweeping regulation would prohibit medical providers from providing gender-affirming care unless a number of requirements are met. While some of the regulation's requirements are specified by age group, its most expansive provisions, including a potential three-year delay in care, would be in place regardless of the patient's age.

Bailey's proposal would go into effect on April 27 and last until February 6, 2024.

The ACLU of Missouri and Lambda Legal responded with a joint statement promising legal action against the attorney general and emergency regulation. "We will defend the rights of transgender people through any necessary legal action, just as we have done in other states engaging in this anti-science and discriminatory fearmongering."

The statement added: "The Attorney General's so-called emergency rule is based on distorted, misleading, and debunked claims and ignores the overwhelming body of scientific and medical evidence supporting this care as well as the medical experts and doctors who work with transgender people every day."

The ACLU of Missouri had previously said that the attorney general, a Republican, overstepped his authority when it condemned Bailey's initial announcement of the policy in March. The state attorney general is basing his regulation on a law aimed at fraudulent business practices, The Missouri Independent reported.

"During the first months since being appointed as Missouri's Attorney General, Andrew Bailey has politicized his office by inserting himself into highly coordinated administrative, legislative, and alt-right media-driven attacks on transgender youth," PROMO, an LGBTQ+ public policy and advocacy organization in the state, said in response to the regulation. "His actions today fanned the flames of hate by including transgender adults' ability to access care in his culture war."

The proposal includes two potentially year-plus delays in care if a medical provider cannot document previous care.

A provider would need to show that a patient has a "medically documented, long-lasting, persistent and intense pattern of gender dysphoria" for "at least the 3 most recent consecutive years" before seeking treatment and that they have received "a full psychological or psychiatric assessment" over at least 18 months consisting of at least 15 hours worth of therapy.

Adults with depression or other mental health issues would not be able to receive gender-affirming care until those existing issues "have been treated and resolved," the regulation says.

Patients would also need to be screened for autism.

Before care could be administered, the regulation also requires that parents or guardians be provided a 23-bullet pointed list of reasons questioning gender-affirming care, citing international restrictions, studies, and journal articles. As The Missouri Independent pointed out, one of the studies cited was later revised after academics questioned its methodology.

Republicans and conservatives have moved to restrict gender-affirming care and other trans rights in recent years. GOP governors in Indiana and Idaho just signed into law bans on minors receiving such care last week. Bailey's restrictions on adult care may signal a new wave of restrictions to come.